It's no secret that there's a pretty huge primary care shortage. What do you guys think would happen if there were a new set of medical schools that were affiliated with ACGME residencies, but ONLY in primary care? They'd presumably be easier to get accepted, have a curriculum geared toward primary care (ex: a shorter surgery rotation), still grant an MD (or DO?) degree, but you could only match into certain residency programs.
Besides pissing a lot of people off, I think it could help ease the primary care shortage. Obviously this would never happen. But what if it did?
Couple of problems. First, I think you don't understand that med school is already just the bare bones education needed for any medical specialty, primary care or not. You wouldn't want a shorter surgery rotation in primary care. Many primary care residents again do another surgery rotation during residency. Why? Because every primary care patient you recommend for surgery is going to have lots of questions, and you are the doctor with the relationship with them. Your being able to answer questions because you already saw a lap chole, etc, in other words the superior training and knowledge, is what separates you from the midlevels. Similarly, you need to be able to talk intelligently to your conultants. There is already a great divide in those conversations when you have a specialist who did five years of residency and fellowship trying to explain something to the hospitalist who finished a three year more generalized residency, but i dont think you'd want to compound this gap further by separating their basic med school education as well. You dont practice in a vacuum, so a lot of what you need to know to do your job is a basic understanding of everyone else you interact withs jobs as well, at least a little. You don't really want a path where you graduate from med school knowing less. Med school already has a certain amount if elective time built in (especially in fourth year) and you totally could tailor that to things that might be more helpful in a primary care route. Hence no need for the change.
Second, most med students change their minds at least once during med school. You want the ability to change your mind after seeing more. Or changing residencies later (there's always someone in the Gen Res board looking to make a switch). You don't want to lock yourself in to the wrong set of choices because you didn't have the broad med school education that is a foundation for everything.
Third, like college was for med school, med school is just foundation for residency. You don't learn to do primary care in med school and shouldn't. You learn what you need to start pretty low in the learning curve of an intern year. It's not like people are coming out of med school knowing things useful for FM, IM, derm, ortho, radiology, anesthesiology. They got just a taste of those and other things, barely enough to decide if they even liked it. no reason primary care shouldn't have the same tastes. We aren't talking about any sort if substantive learning as is.
Fourth, med school can never address shortages in medicine. The number of residency slots and their allocation does this. You want more primary care then reduce the number of specialist spots and increase the number of primary care spots. And that's if you even believe there is a shortage rather than a geographic distribution issue. But either way there's nothing useful that would have to happen at the med school level to effect this change. As US med school enrollment starts to approximate the number if residency slots, the primary care spots will fill with US grads, naturally, or some people will end up without residency.
